Safety and efficacy of balloon-mounted stent in the treatment of symptomatic intracranial atherosclerotic disease: a multicenter experience

Background Randomized clinical trials have failed to prove that the safety and efficacy of endovascular treatment for symptomatic intracranial atherosclerotic disease (ICAD) is better than that of medical management. A recent study using a self-expandable stent showed acceptable lower rates of periprocedural complications. Objective To study the safety and efficacy of a balloon-mounted stent (BMS) in the treatment of symptomatic ICAD. Methods Prospectively maintained databases from 15 neuroendovascular centers between 2010 and 2020 were reviewed. Patients were included if they had severe symptomatic intracranial stenosis in the target artery, medical management had failed, and they underwent intracranial stenting with BMS after 24 hours of the qualifying event. The primary outcome was the occurrence of stroke and mortality within 72 hours after the procedure. Secondary outcomes were the occurrence of stroke, transient ischemic attacks (TIAs), and mortality on long-term follow-up. Results A total of 232 patients were eligible for the analysis (mean age 62.8 years, 34.1% female). The intracranial stenotic lesions were located in the anterior circulation in 135 (58.2%) cases. Recurrent stroke was the qualifying event in 165 (71.1%) while recurrent TIA was identified in 67 (28.9%) cases. The median (IQR) time from the qualifying event to stenting was 5 (2–20.75) days. Strokes were reported in 13 (5.6%) patients within 72 hours of the procedure; 9 (3.9%) ischemic and 4 (1.7%) hemorrhagic, and mortality in 2 (0.9%) cases. Among 189 patients with median follow-up time 6 (3–14.5) months, 12 (6.3%) had TIA and 7 (3.7%) had strokes. Three patients (1.6%) died from causes not related to stroke. Conclusion Our study has shown that BMS may be a safe and effective treatment for medically refractory symptomatic ICAD. Additional prospective randomized clinical trials are warranted

Sustainable Remedy Waste to Generate SiO2 Functionalized on Graphene Oxide for Removal of U(VI) Ions

The Hummer process is applied to generate graphene oxide from carbon stocks’ discharged Zn-C batteries waste. SiO2 is produced from rice husks through the wet process. Subsequently, SiO2 reacted with graphene oxide to form silica/graphene oxide (SiO2/GO) as a sorbent material. XRD, BET, SEM, EDX, and FTIR were employed to characterize SiO2/GO. Factors affecting U(VI) sorption on SiO2/GO, including pH, sorption time, a dosage of SiO2/GO, U(VI) ions’ concentration, and temperature, were considered. The experimental data consequences indicated that the uptake capacity of SiO2/GO towards U(VI) is 145.0 mg/g at a pH value of 4.0. The kinetic calculations match the pseudo second-order model quite well. Moreover, the sorption isotherm is consistent with the Langmuir model. The sorption procedures occur spontaneously and randomly, as well as exothermically. Moreover, SiO2/GO has essentially regenerated with a 0.8 M H2SO4 and 1:50 S:L phase ratio after 60 min of agitation time. Lastly, the sorption and elution were employed in seven cycles to check the persistent usage of SiO2/GO. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.The authors express their gratitude to Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2022R13), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability.

BACKGROUND AND PURPOSE We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability. METHODS In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0-4 and LVO who underwent EVT 6-24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0-2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2-4) and those without (mRS score 0-1). RESULTS A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43-1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995). CONCLUSION A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Background and purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P&lt;0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P&lt;0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction

Global impact of COVID-19 on stroke care and IV thrombolysis

Objective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.Paroxysmal Cerebral Disorder

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality.

BACKGROUND AND PURPOSE: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. CONCLUSIONS: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

Decontamination of Uranium-Polluted Groundwater by Chemically-Enhanced, Sawdust-Activated Carbon

The preparation of highly efficient and low-cost activated carbon from sawdust was achieved for the treatment of uranium-contaminated groundwater. The adsorption properties of the synthesized activated carbon, as well as their ability to be reused, were assessed. The obtained results demonstrated that sawdust activated carbon (SDAC) and its amine form (SDACA) had high affinity towards uranium ions at pH values of 4.5 and 5 for SDAC and SDACA, respectively. The experimental results showed that the maximum adsorption capacity of uranium was 57.34 and 76.7 mg/g for SDAC and SDACA, respectively. A maximum removal efficiency of 89.72% by SDAC and 99.55% by SDACA were obtained at a solid/liquid ratio of 8 mg/mL. The removal mechanism of uranium by SDAC and SDACA was suggested due to interaction with the amine and carboxylic groups. The validation of the method was verified through uranium separation from synthetic as well as from groundwater collected from water wells in the Wadi Naseib area, Southwestern Sinai, Egypt

Abstract Number ‐ 51: Automated Versus Human Hyperdense Vessel Sign Detection Using Non‐Contrast Computed Tomography Scans

Introduction Rapid detection of large vessel occlusion (LVO) is very crucial in triaging stroke patients potentially candidates for mechanical thrombectomy (MT). Hyperdense vessel sign (HDVS) is one of the earliest ischemic changes in non‐contrast CT scan (NCCT) indicating LVO stroke. Artificial intelligence emerged to detect HDVS with the advantages of faster acquisition, less variation, and a lower need for experience than the usual detection. We aimed to identify the diagnostic performance of automated software (e‐Stroke, Brainomix) in HDVS detection. Methods A prospectively collectedMT database from March 2020 to August 2021 was reviewed. Patients were included if they had intracranial internal carotid artery or middle cerebral artery M1 or M2 occlusion. Cases with HDVS were identified through the routine 2.5‐mm slice thickness NCCT scans after being correlated with patients’ clinical information and confirmed with CT angiography (CTA) scans. NCCT scans were classified according to slice thickness into two groups: 2.5‐mm scans and 0.625‐mm generated scans. All NCCT scans were read by e‐Stroke software, then deidentified and reviewed by two stroke neurologists who were blinded to any clinical, other imaging, or therapeutic information. They were required to record the presence/laterality of HDVS before and after observing other NCCT early ischemic changes like gaze deviation, loss of insular ribbon, caudate or lentiform hypodensity. ROC curve analysis was used to estimate sensitivity and specificity and the area under the curve (AUC) was compared using DeLong’s test. Inter‐rater agreement between the two readers’ final reads, e‐Stroke, and the standard read was measured using the Fleiss Kappa test. Results Among 304 patients included in the study, 37.7% had HDVS. Approximately 44% of the scans had 2.5‐mm slice thickness and 56% had 0.625‐mm slice thickness. The e‐Stroke software identified HDVS with a sensitivity of 63% and a specificity of 71% (Table 1). The mean AUC value of e‐Stroke HDVS detection (0.67[0.61‐0.74]) was similar to reader‐1 (0.68[0.62‐0.74];p = 0.87) and reader‐2 (0.63[0.57‐0.70];p = 0.56). HDVS detection improved by reader‐1(0.78[0.72‐0.83];p = 0.03) after observing other early ischemic changes on the same scans, but reader‐2 performance remained similar to e‐Stroke (0.69[0.63‐0.76];p = 0.71). AUC, sensitivity and specificity ofHDVS detection by e‐Stroke were significantly higher using 2.5‐mm compared to 0.625‐mm sliced NCCT scans (0.78[0.70‐0.86],sensitivity 70%,specificity 86%;p< 0.001) vs (0.58[0.50‐0.67],sensitivity 56%,specificity 61%;p = 0.06) respectively;p = 0.01. The readers also had higher AUC values with 2.5‐mm scans but not statistically significant, (0.74[0.66‐0.83] vs 0.64[0.56‐0.73];p = 0.18) for reader‐1 and (0.68[0.59‐0.77] vs 0.57[0.48‐0.66];p = 0.23) for reader‐2. The same after the final read, (0.85[0.78‐0.92] vs 0.75[0.67‐0.82];p = 0.08) for reader‐1 and (0.73[0.65‐0.82] vs 0.67[0.58‐0.76];p = 0.43) for reader‐2. Similarly, inter‐rater agreement was higher using 2.5‐mm sliced scans, k = 0.50(0.43‐0.75) compared to0.625‐mm scans,k = 0.27(0.21‐0.33). Conclusions Artificial intelligence (e‐Stroke software) has comparable sensitivity and specificity to human readers in HDVS detection. For e‐Stroke software, 2.5‐mm sliced CT scans are better to identifyHDVS compared to 0.625‐mm scans